Abstract

Chlamydia trachomatis and Chlamydia pneumoniae together comprise the most frequent causative pathogens that elicit reactive arthritis (ReA). Advances in our understanding
of the molecular biology/molecular genetics of these organisms have improved significantly the ability to detect chlamydiae
in the joint for diagnostic purposes, as well as extending our current understanding of the pathogenic processes they elicit
in the joint and elsewhere. An important aspect of the latter is that synovial chlamydiae infect the joint in an unusual but
metabolically active state. While some standard treatments can provide a palliative effect on the ReA disease phenotype, many
reports have indicated that standard antibiotic treatment does not provide a cure. Of critical importance, however, two recent
reports of controlled clinical trials demonstrated that Chlamydia-ReA can be treated successfully using combination antibiotic therapy. These observations offer the opportunity of a cure
for this disease, thereby increasing the practical importance of awareness and diagnosis of the spondyloarthritis caused by
Chlamydia. In this viewpoint, we provide an overview of recent key findings in the epidemiology, pathophysiology, clinical manifestations,
diagnosis and treatment of Chlamydia-induced arthritis. Our intention is for these insights to be translated rapidly into clinical practice to overcome misdiagnosis
and underdiagnosis of the disease, and for them to stimulate the continued development of a cure.